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Colunga A, Carlson BE, Olufsen MS. The importance of incorporating ventricular-ventricular interaction (VVI) in the study of pulmonary hypertension. Math Biosci 2024; 375:109242. [PMID: 38944112 DOI: 10.1016/j.mbs.2024.109242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
Ventricular ventricular interaction (VVI) affects blood volume and pressure in the right and left ventricles of the heart due to the location and balance of forces on the septal wall separating the ventricles. In healthy patients, the pressure of the left ventricle is considerably higher than the right, resulting in a septal wall that bows into the right ventricle. However, in patients with pulmonary hypertension, the pressure in the right ventricle increases significantly to a point where the pressure is similar to or surpasses that of the left ventricle during portions of the cardiac cycle. For these patients, the septal wall deviates towards the left ventricle, impacting its function. It is possible to study this effect using mathematical modeling, but existing models are nonlinear, leading to a system of algebraic differential equations that can be challenging to solve in patient-specific optimizations of clinical data. This study demonstrates that a simplified linearized model is sufficient to account for the effect of VVI and that, as expected, the impact is significantly more pronounced in patients with pulmonary hypertension.
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Affiliation(s)
- Amanda Colunga
- North Carolina State University, 2311 Stinson Drive, Raleigh, 27695, NC, USA
| | - Brian E Carlson
- University of Michigan, 2800 Plymouth Rd, Ann Arbor, 48105, MI, USA
| | - Mette S Olufsen
- North Carolina State University, 2311 Stinson Drive, Raleigh, 27695, NC, USA.
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Nordlund D, Lav T, Jablonowski R, Khoshnood A, Ekelund U, Atar D, Erlinge D, Engblom H, Arheden H. Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clin Cardiol 2024; 47:e24216. [PMID: 38269628 PMCID: PMC10790509 DOI: 10.1002/clc.24216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea ) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). METHODS A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2-6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax ) reflecting contractility, Ea , ventriculoarterial coupling (Ea /Emax ), SW, potential energy, external power, energy per ejected volume, and efficiency. RESULTS All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax : 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea /Emax : 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax : r2 = 0.25 and r2 = 0.29; Ea /Emax : r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). CONCLUSIONS Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.
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Affiliation(s)
- David Nordlund
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Theodor Lav
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Robert Jablonowski
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences Malmö, Emergency Medicine, Lund UniversitySkane University HospitalMalmöSweden
| | - Ulf Ekelund
- Department of Clinical Sciences Lund, Emergency MedicineLund University and Skane University HospitalLundSweden
| | - Dan Atar
- Dept. of CardiologyOslo University Hospital UllevalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - David Erlinge
- Cardiology, Department of Clinical Sciences LundLund University and Skane University HospitalLundSweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical PhysiologyLund University and Skane University HospitalLundSweden
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Arvidsson PM, Green PG, Watson WD, Shanmuganathan M, Heiberg E, De Maria GL, Arheden H, Herring N, Rider OJ. Non-invasive left ventricular pressure-volume loops from cardiovascular magnetic resonance imaging and brachial blood pressure: validation using pressure catheter measurements. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad035. [PMID: 37969333 PMCID: PMC10631830 DOI: 10.1093/ehjimp/qyad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023]
Abstract
Aims Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. A non-invasive method for the computation of PV loops from magnetic resonance imaging and brachial cuff blood pressure has recently been proposed. Here we evaluated the fidelity of the non-invasive PV algorithm against invasive LV pressures in humans. Methods and results Four heart failure patients with EF < 35% and LV dyssynchrony underwent cardiovascular magnetic resonance (CMR) imaging and subsequent LV catheterization with sequential administration of two different intravenous metabolic substrate infusions (insulin/dextrose and lipid emulsion), producing eight datasets at different haemodynamic states. Pressure-volume loops were computed from CMR volumes combined with (i) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, or (ii) invasive pressures averaged from 19 to 30 sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Non-invasively derived PV loop parameters demonstrated high correlation and low bias when compared to invasive data for stroke work (R2 = 0.96, P < 0.0001, bias 4.6%), potential energy (R2 = 0.83, P = 0.001, bias 1.5%), end-systolic pressure-volume relationship (R2 = 0.89, P = 0.0004, bias 5.8%), ventricular efficiency (R2 = 0.98, P < 0.0001, bias 0.8%), arterial elastance (R2 = 0.88, P = 0.0006, bias -8.0%), mean external power (R2 = 0.92, P = 0.0002, bias 4.4%), and energy per ejected volume (R2 = 0.89, P = 0.0001, bias 3.7%). Variations in estimated end-diastolic pressure did not significantly affect results (P > 0.05 for all). Intraobserver analysis after one year demonstrated 0.9-3.4% bias for LV volumetry and 0.2-5.4% for PV loop-derived parameters. Conclusion Pressure-volume loops can be precisely and accurately computed from CMR imaging and brachial cuff blood pressure in humans.
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Affiliation(s)
- Per M Arvidsson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Peregrine G Green
- Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - William D Watson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
- Department of Cardiovascular Medicine, Heart and Lung Research Institute, Papworth Road, Cambridge CB2 0AY, United Kingdom
| | - Mayooran Shanmuganathan
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
- Cardiology Department, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, Queen Alexandra Road, High Wycombe HP11 2TT, United Kingdom
- Heart Transplant Department, Harefield Hospital, Royal Brompton and Harefield Hospitals, Hill End Road, Harefield UB9 6JH, United Kingdom
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - Oliver J Rider
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
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Lindholm A, Kjellström B, Seemann F, Carlsson M, Hesselstrand R, Rådegran G, Arheden H, Ostenfeld E. Atrioventricular plane displacement and regional function to predict outcome in pulmonary arterial hypertension. Int J Cardiovasc Imaging 2022; 38:2235-2248. [PMID: 37726454 PMCID: PMC10509124 DOI: 10.1007/s10554-022-02616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
To investigate if left and right atrioventricular plane displacement (AVPD) or regional contributions to SV are prognostic for outcome in patients with pulmonary arterial hypertension (PAH). Seventy-one patients with PAH and 20 sex- and age-matched healthy controls underwent CMR. Myocardial borders and RV insertion points were defined at end diastole and end systole in cine short-axis stacks to compute biventricular volumes, lateral (SVlat%) and septal (SVsept%) contribution to stroke volume. Eight atrioventricular points were defined at end diastole and end systole in 2-, 3- and 4-chamber cine long-axis views for computation of AVPD and longitudinal contribution to stroke volume (SVlong%). Cut-off values for survival analysis were defined as two standard deviations above or below the mean of the controls. Outcome was defined as death or lung transplantation. Median follow-up time was 3.6 [IQR 3.7] years. Patients were 57 ± 19 years (65% women) and controls 58 ± 15 years (70% women). Biventricular AVPD, SVlong% and ejection fraction (EF) were lower and SVlat% was higher, while SVsept% was lower in PAH compared with controls. In PAH, transplantation-free survival was lower below cut-off for LV-AVPD (hazard ratio [HR] = 2.1, 95%CI 1.2-3.9, p = 0.02) and RV-AVPD (HR = 9.8, 95%CI 4.6-21.1, p = 0.005). In Cox regression analysis, lower LV-AVPD and RV-AVPD inferred lower transplantation-free survival (LV: HR = 1.16, p = 0.007; RV: HR = 1.11, p = 0.01; per mm decrease). LV-SVlong%, RV-SVlong%, LV-SVlat%, RV-SVlat%, SVsept% and LV- and RVEF did not affect outcome. Low left and right AVPD were associated with outcome in PAH, but regional contributions to stroke volume and EF were not.
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Affiliation(s)
- Anthony Lindholm
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
| | - Barbro Kjellström
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Felicia Seemann
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Rheumatology, and the Clinic for Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, and the Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
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Arvidsson PM, Nelsson A, Magnusson M, Smith JG, Carlsson M, Arheden H. Hemodynamic force analysis is not ready for clinical trials on HFpEF. Sci Rep 2022; 12:4017. [PMID: 35256713 PMCID: PMC8901629 DOI: 10.1038/s41598-022-08023-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/22/2022] [Indexed: 01/11/2023] Open
Abstract
Hemodynamic force analysis has been proposed as a novel tool for early detection of subclinical systolic dysfunction in heart failure with preserved ejection fraction (HFpEF). Here we investigated the ability of hemodynamic forces to discriminate between healthy subjects and heart failure patients with varying degrees of systolic dysfunction. We studied 34 controls, 16 HFpEF patients, and 25 heart failure patients with mid-range (HFmrEF) or reduced ejection fraction (HFrEF) using cardiac magnetic resonance with acquisition of cine images and 4D flow at 1.5 T. The Navier-Stokes equation was used to compute global left ventricular hemodynamic forces over the entire cardiac cycle. Forces were analyzed for systole, diastole, and the entire heartbeat, with and without normalization to left ventricular volume. Volume-normalized hemodynamic forces demonstrated significant positive correlation with EF (r2 = 0.47, p < 0.0001) and were found significantly lower in heart failure with reduced ejection fraction compared to controls (p < 0.0001 for systole and diastole). No difference was seen between controls and HFpEF (p > 0.34). Non-normalized forces displayed no differences between controls and HFpEF (p > 0.24 for all analyses) and did not correlate with EF (p = 0.36). Left ventricular hemodynamic force analysis, whether indexed to LV volumes or not, is not ready for clinical trials on HFpEF assessment.
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Affiliation(s)
- Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - Martin Magnusson
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden.
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